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Clinical Case Presentation: Alcoholic Liver Disease

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Clinical Case Presentation:Ascites with ARF • Lakshmi Narayan, 42 years old patient , who is a chronic alcoholic, farmer by occupation presented with: • Abdominal distension from 15 days • Abdominal pain from 15 days • Fever from 15 days • Decreased urine output from 10 days • Decreased passage of stools from 10 days

Differential Diagnosis: • Based on clinical, lab & USG findings, patient is suffering from Chronic Liver Disease showing complications of Ascites and Portal Hypertension with derangement of KFT, cause of which can be 1) Hepato-Renal Syndrome 2) Pre –Renal Azotemia • High SAAG in the case indicates presence of Portal Hypertension. • Low Ascitic Protein (1.5g/dl) indicates Transudative Ascites. • Based on patients alcoholic history & lab findings,Cirrhosis is the cause of Ascitis and Portal Hypertension. • Complete Urine Analysis within normal limit shows that Chronic Kidney Disease is not the cause of acute renal failure. • Hereditary causes of Cirrhosis are ruled out based on family history while patient gives no history of skin pigmentation,xanthoma and jaundice which rules out Biliary Cirrhosis.

Alcohol Liver Disease • Chronic alcohol ingestion is one of the major causes of liver disease. • It causes 3 major lesions: a)fatty liver b)alcoholic hepatitis c)cirrhosis • Quantity and Duration of alcohol intake are the major risk factors.160g/d for 10-20 years in man produces cirrhosis. • Hepatic metabolism of alcohol initiates a process that promotes lipogenesis& the inhibition of fatty-acid oxidation. Endotoxins, oxidative stress, immunologic activity, and pro-inflammatory cytokine release contribute to the resulting liver injury. • Alcoholic fatty liver and hepatitis is reversible with alcohol abstention but cirrhosis is not. • Diagnosis is based on AST, ALT, GGTP, Bilirubin and USG findings.